title: Prevalence of anal intraepithelial neoplasia defined by anal cytology screening and high-resolution anoscopy in a primary care population of HIV-infected men and women.
abstract: BACKGROUND
  Prevalence of high-grade anal intraepithelial neoplasia, the human papillomavirus-associated putative anal cancer precursor, is high in HIV-infected men who have sex with men, but less is known about its prevalence in other HIV-infected subgroups. Similarly, the prevalence of abnormal cytology, used as a screen, is not well-defined in these subgroups.
  
  
  OBJECTIVE
  This study aimed to estimate the prevalence of abnormal cytology and anal intraepithelial neoplasia in a primary care HIV-infected population.
  
  
  METHODS
  This investigation was designed as a cross-sectional study.
  
  
  METHODS
  This study took place at a Ryan White-funded clinic.
  
  
  METHODS
  Included in the study were all (n = 779) HIV-infected patients receiving primary care services between March 2006 and March 2008.
  
  
  METHODS
  The main outcome measures were anal cytology and high-resolution anoscopy results.
  
  
  RESULTS
  The prevalence of abnormal cytology was 43%: 62% in men who reported receptive anal intercourse, 39% in women who reported receptive anal intercourse, and 25% in all others (P trend <.0001). High-grade anal intraepithelial neoplasia prevalence was 27%: 44% in men who reported receptive anal intercourse, 26% in women who reported receptive anal intercourse, and 10% in all others (P trend <.0001). Two patients had squamous-cell cancer. Independent predictors of dysplasia were CD4 at screening, receptive anal intercourse, sexual orientation, and history of human papillomavirus disease. Anal cytology and histology findings were not well correlated.
  
  
  CONCLUSIONS
  The study population may not be representative of the general HIV-infected population, there were differences between screened and unscreened patients and between patients with abnormal cytology who had high-resolution anoscopy and those who did not, only patients with abnormal cytology had high-resolution anoscopy, and there were possible misclassification errors and uncontrolled possible confounders.
  
  
  CONCLUSIONS
  High-grade anal intraepithelial neoplasia is relatively common in HIV-infected patients regardless of sexual practice. Although risk increases with receptive anal intercourse, patient-provided information on this sexual practice should not be used as a determining factor for screening. Strategies to prevent anal cancer are necessary for all HIV-infected patients.
authors.affiliation: Department of Internal Medicine, University of North Texas Health Science Center at Fort Worth, Fort Worth, Texas, USA. sweis@hsc.unt.edu
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Weis
authors.forename: Isabel
authors.initials: I
authors.lastname: Vecino
authors.forename: Janice M
authors.initials: JM
authors.lastname: Pogoda
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Susa
authors.forename: Jason
authors.initials: J
authors.lastname: Nevoit
authors.forename: Deborah
authors.initials: D
authors.lastname: Radaford
authors.forename: Paula
authors.initials: P
authors.lastname: McNeely
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Colquitt
authors.forename: Elvin
authors.initials: E
authors.lastname: Adams
mesh_terms: D000328:Adult; D001005:Anus Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000821:virology; D001706:Biopsy; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000473:pathology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D030361:Papillomavirus Infections / Q000453:epidemiology / Q000473:pathology*; D015995:Prevalence; D011320:Primary Health Care; D011351:Proctoscopy; D011446:Prospective Studies; D012307:Risk Factors; D012309:Risk-Taking; D012725:Sexual Behavior